| Autor: |
Højstrup S; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Hansen KW; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Talleruphuus U; Department of Clinical Physiology and Nuclear Medicine Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Marner L; Department of Clinical Physiology and Nuclear Medicine Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Galatius S; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Rauf M; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Bjerking LH; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Jakobsen L; Department of Cardiology Aarhus University Hospital Aarhus Denmark., Christiansen EH; Department of Cardiology Aarhus University Hospital Aarhus Denmark., Bouchelouche K; Department of Nuclear Medicine & PET Center Aarhus University Hospital Aarhus Denmark., Christensen H; Department of Neurology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark., Prescott EIB; Department of Cardiology Copenhagen University Hospital, Bispebjerg and Frederiksberg Frederiksberg Denmark. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2023 Jun 20; Vol. 12 (12), pp. e028767. Date of Electronic Publication: 2023 Jun 15. |
| DOI: |
10.1161/JAHA.122.028767 |
| Abstrakt: |
Background Coronary microvascular disease (CMD) may be part of a systemic small vessel disease that also manifests as neurological impairment and kidney disease. However, clinical evidence supporting a potential link is scarce. We assessed whether CMD is associated with an increased risk of small vessel disease in the kidney and brain. Methods and Results A retrospective multicenter (n=3) study of patients clinically referred to 82-rubidium positron emission tomography myocardial perfusion imaging was conducted between January 2018 and August 2020. Exclusion criterion was reversible perfusion defects >5%. CMD was defined as myocardial flow reserve (MFR) ≤2. The primary outcome, microvascular event, was defined by hospital contact for chronic kidney disease, stroke, or dementia. Among 5122 patients, 51.7% were men, median age 69.0 [interquartile range, 60.0-75.0] years, 11.0% had left ventricular ejection fraction ≤40%, and 32.4% had MFR ≤2. MFR was associated with baseline estimated glomerular filtration rate after multivariable adjustment ( β =0.04 [95% CI, 0.03-0.05]; P <0.001). During a median follow-up of 3.05 years, 383 (7.5%) patients suffered an event (253 cerebral and 130 renal), more frequently in patients with MFR ≤2 versus MFR >2 (11.6% versus 5.5%, P <0.001). MFR ≤2 was associated to outcome with a hazard ratio (HR) of 2.30 (95% CI, 1.88-2.81, P <0.001) and an adjusted HR of 1.62 (95% CI, 1.32-2.00, P <0.001). Results were consistent across subgroups defined by presence of irreversible perfusion defects, estimated glomerular filtration rate, diabetes, left ventricular ejection fraction, and previous revascularization. Conclusions This is the first large-scale cohort study to link CMD to microvascular events in the kidney and brain. Data support the hypothesis that CMD is part of a systemic vascular disorder. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
|
Plný text